California is well behind almost every other state when it comes to caring for its kids, according to an annual report from the Annie E. Casey Foundation and its Oakland-based partner, Children Now.

The report looks at four indicators of children’s well-being: family stability, economic stability, health, and education. This year, California inched up one spot to 40th overall, but ranked 26th in the health category.

Some of that progress is due to the expansion of health insurance under the Affordable Care Act, though advocates say there is still work to be done.

“We have increased the number of children now that are on Medi-Cal,” said Jessica Mindnich, research director at Children Now. “But do these kids actually have access to doctors and to dentists? Are they able to get in in a timely manner?”

California dropped several small health care programs for children during the recession, including one that provided dental care to low-income kids at their schools. These losses, Mindnich says, can affect many aspects of children’s well-being.

“We need to restore our safety net programs that we had for kids, so that we can make sure all kids are healthy, that all kids are safe, and that all kids are in school and learning,” said Mindnich.

The state did make strides in one area. California’s teen birth rate has fallen 63 percent since 1990, the largest decline of all states. Mindnich attributes the progress to improved sex education policies and wider access to contraceptives.

“It’s because we had committed leadership, and we had sustained efforts dating back to 1992,” said Mindnich. “So we know that we can see these numbers improve.”

Other states have bumped up their rankings by getting more kids into early education and ensuring they have full access to quality health care.

“California is a unique state. We’re much more diverse, and much larger than a state like Massachusetts. And I think because of our size and diversity, I don’t think it’s going to be as simple as it may be in other states. Our policies will need to be more nuanced.”

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About State of Health

California faces health care challenges seen across the country. At a time of intense focus on reform, "State of Health" explores these issues and more, bringing you stories of challenge and change in the Golden State. The blog is edited by Lisa Aliferis.